HomeMy WebLinkAbout49328-Z � rr TOWN OF SOUTHOLD
BUILDING DEPARTMENT
x TOWN CLERK'S OFFICE
b SOUTHOLD, NY
s
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 49328 Date: 6/1/2023
Permission is hereby granted to:.
Racanelli, Steven
175 Oxford Blvd
Garden City, NY 11530
To construct accessory in-ground swimming pool as applied for.
At premises located at:
1200 Arbor Ln, Mattituck
SCTM #473889
Sec/Block/Lot# 121.4-1.9
Pursuant to application dated 5/4/2023 and approved by the Building Inspector.
To expire on 11/30/2024.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt 7� _w,,v. outl)oldto�vnny v
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ��k, ,a Im„-;u ”
.
PERMIT NO,-4vu- Building Ir, ecr:
2923
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Applications and forms must be fill �
pp ed out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,anw�'ii" "ii"m' i
Owner's Authorization form(Page 2)shall be completed.
Date. VaA,-j SJ
OWNER(S)OF PRO RTY:
Name:Eieu,-
SCTM#1000- .�
Project Address:
Phone#: (�y-;
Email: 5 �.C
-�La �l
Mailing dress:
CONTACT PERSON:
Mailing Address: - i I'
Phone#: C<��VVI
DESIGN PROFESSIONAL INFORMATION:
Name:
z
Mailing Address: �+Oluk)V-Icrt-s "Yoo
Phone -� Email:
CONTRACTOR.INFORMATION:
Name:
Mailing Address:
P
hone Email:
................. ---- - Jim
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure
❑Addition ❑Alteration ❑Kepair ❑Demolition Estla e Cast of Pmeq
Cher
Will the lot be re-graded? Eyes ea Will excess fill be removed from premises? ❑Yes
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes 1-ANo IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and'regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a.Class A misdemeanor pursuant to Section 210,45 of the New York State Penal Laid,
TApplication Submitted By(pri ame): 0,-zk(l k6Ejuthorized Agent
Signature of Applicant: Dat,eM ,
�l L L Alzz
STATE OF ,� i`
C ✓
NEW YORK) � ^4,",,
CSS:
„ , vV
COUNTY OF
o _
Y ppe IName of individ s' QZ&6k!2,�Ibeingduly sw � tilat( )he is the applicant
( individual Igni g contract) above named, � � Fi g�iriuV ',
(S)he is the
(Contractor,Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
C�—Lday of3
Notary Public
PROPERTY OWNER ER AUTHORIZATION
(Where the applicant is not the owner)
u
I
I. ' . (I, ,residing at
do hereby authorize to apply I on
my lMlt to t e n of Southold Building Department for approval as described herein.
" Owne n ure Date
K/
Print Owner's Name
2